Every year my partnership has an annual retreat. We hear from our 401(k) guy (who amusingly always tries to predict the future,) we get to compare ourselves to how the other divisions within the partnership are doing financially, we get to learn a little bit about risk management, and we get to hear about the threats to our business from publicly-traded, predatory corporations in Emergency Medicine like EMCare and TeamHealth who are constantly trying to steal contracts from small democratic groups. But we also usually bring in a paid keynote speaker. This year's speaker was Dike Drummond, AKA The Happy MD, author of Stop Physician Burnout.
The Unhappy MD
Actually, Dike wasn't a very happy MD, and in fact, no longer practices medicine at all because he burned out of Family Practice at 40. He now does coaching to individual MDs as well as groups of MDs in order to help them avoid burnout and to treat burnout. Apparently, that's about when most people burnout, around age 40, after about 40,000 patient visits. He think that is because at that point in your career you are seeing very few conditions and presentations for the first time, so your job becomes much more routine. You're now building widgets on the assembly line I guess rather than having a profound intellectual experience.
I think there is some wisdom there. I loved residency, even though it was definitely a brutal job. But everything was so new and cool all the time it was worth putting up with the terrible hours, constant variation, odd attendings, and stress. The worst part about docs burning out at 40 is that is when they are most competent. In fact, if you survey patients, they want their doctors to be 40. That puts them far enough out of their training that they're competent, but not so far out that they're not up to date on the latest stuff. What I've personally noted about 40 is that it is becoming very rare for a patient to ask me if I'm old enough to be their doc anymore, a question I used to get multiple times a day. I don't tell them I'm rapidly approaching financial independence/retirement.
But Dike does a great 90 minute training session for docs and their spouses over dinner and drinks. I was able to corner him earlier that afternoon to talk business with him. I was impressed with how he runs his speaking/training gigs, and he was impressed with how many of you come by this site.
More Ways to Fight Burnout
Prior to Dike's presentation, my approach to burnout has been primarily financial. I figured that if a doc took care of her finances, she would be financially free to do whatever she wanted in her practice. If she wants to take longer with patients, she can afford to do that. If she wants to work shorter hours or fewer days she can do that. If she wants to drop nights or call or whatever, as long as the finances allow, great! However, that approach doesn't work for everybody, and it certainly doesn't work quickly for anyone. Dike provides all kinds of ideas about how to decrease burnout WITHOUT dropping your income significantly. (Although he told me that he has helped five doctors retire. They were burned out and didn't realize they already had “enough.”)
There were two particularly good ideas I took home from the presentation. The first is to establish boundaries between your work and your home life, and to actually have a boundary ritual between them. (Think Mr. Rogers changing his shoes at the start of the show.) As an emergency doc, the boundary between work and home has always been pretty easy for me. I sign-out my patients, hang up my stethoscope, and walk out the door. I'm Me again, and no longer Me, MD. I'm never on call and rarely see the same patient twice. However, the boundary I struggle with is the boundary between Me and WCI. As my wife will tell you, sometimes I'm home but not really home. As you might imagine, an enterprise like this has a way of expanding to fill all available time. So I'm working on coming up with a good way to draw boundaries around WCI to allow me to do things that I also enjoy.
The Ideal Life
The second good idea is to use a Venn Diagram to improve your practice and/or your life. Basically, the circle on the left is your ideal practice/life. The circle on the right is your current practice/life.
The amount of overlap determines how happy you are. Drummond says if the overlap is 60% or more, you are likely very happy and unlikely to burn out. If it is 20% or less, watch out! You are very likely to burn out very soon. I felt pretty good about that, since just before he gave out those guidelines, I leaned over and told my wife I had 60-80% overlap. Once I cut my shifts back a little bit next summer and drop my night shifts, I figure my practice Venn Diagram overlap may be over 90%.
Then I started thinking about applying this principle to my entire life. I asked myself, if I could live anyway I want with no financial considerations, what would that life look like? Here is the list I've come up with so far:
- 8-10 eight hour shifts per month in the ED.
- Never work after 1 am.
- Have 80% of evenings free for volunteer work, time with spouse and kids, or time to play on a sports team.
- Have 3/4 of holidays and weekend days off to spend with family.
- See fewer than 2 patients per hour.
- Time for one 2-4 day trip per month plus one 5-8 day trip per month.
- Four to six speaking gigs per year.
- WCI and writing time: 2 hours per day, four days per week, with one longer session of 4-8 hours per week except when on a trip.
- 4-6 days per month where I have 4-8 hours to play in the Wasatch- climbing, biking, skiing etc.
That's what the left side of my Venn Diagram looks like. Unfortunately, the right side currently looks like this:
- 15 eight hours shifts per month in the ED.
- Work after 1 am 7 days per month
- Have 70% of evenings free for volunteer work, time with spouse and kids, or time to play on a sports team
- Have 1/2 of holidays and weekend days off to spend with family.
- Seeing 1.5 patients per hour.
- Time for either one longer trip, two shorter, OR 4-8 days per month to play in the Wasatch.
- 6-8 speaking/consulting gigs per year.
- WCI and writing time: At least twice what I would ideally be spending.
So there is quite a bit of overlap (? 60%), but I can increase happiness and decrease burnout if I can increase the overlap. I'm taking a significant step this summer when I drop my 10pm-6 am shifts, going from 15 shifts a month to 12. The other step I'm working on is to do a better job limiting my WCI by being better at delegating and drawing better boundaries.
What do you think? What does your Venn Diagram look like? 80% overlap? 20% overlap? What steps can you take to increase the overlap? How have you drawn boundaries in your life? Comment below!